Indravudh Pitchaya P, McGee Kathleen, Sibanda Euphemia L, Corbett Elizabeth L, Fielding Katherine, Terris-Prestholt Fern
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
PLOS Glob Public Health. 2025 Apr 2;5(4):e0004304. doi: 10.1371/journal.pgph.0004304. eCollection 2025.
Control of infectious diseases is a global health priority and a target of the 2015-2030 Sustainable Development Goals (SDGs). Community participation is fundamental to advancing primary health care and meeting SDGs. We conducted a mixed-methods systematic literature review of quantitative and qualitative evidence to understand the health, social, and economic impact of community-led strategies for communicable disease prevention and management in low- and middle- income countries. We searched seven electronic databases through 31 December, 2023 for cluster-randomised trials and economic evaluations of community-led communicable disease control. Reference searches identified additional studies associated with eligible database records. Data extraction and narrative synthesis summarised evidence on impact, costs, and cost-effectiveness, described the nature and extent of community participation, and examined implementation, mechanisms of impact, and contexts. Risk of bias of was assessed using the Cochrane Risk-of-Bias Tool and the Drummond checklist. Our database search yielded 14,269 records. Following database and reference screening, we included 49 records across 16 unique cluster-randomised trials, mostly from sub-Saharan Africa. Communicable disease strategies included provision of biomedical products, environmental modifications, and education and outreach. Based on evidence with moderate risk of bias, we found that community-led strategies can improve health behaviours for diarrhoeal diseases, HIV, malaria, and neglected tropical diseases. Evidence for impact on mortality and morbidity, health care access and utilisation, and community and social outcomes was less conclusive. Impact depended on the intensity of implementation by community actors. Factors facilitating implementation included motivation, trust, and health systems engagement. Contextual influences included attitudes and norms around communicable diseases. Economic studies were few and many omitted societal costs and consequences. This review supports community-led communicable disease control as a potentially effective strategy to improve health behaviours and contribute to SDGs. Operational guidance for implementation and evaluation is critical to support rapid evidence generation in this important area.
传染病控制是全球卫生工作的重点，也是2015-2030年可持续发展目标（SDGs）的一项指标。社区参与是推进初级卫生保健和实现可持续发展目标的基础。我们对定量和定性证据进行了混合方法的系统文献综述，以了解低收入和中等收入国家社区主导的传染病预防和管理策略对健康、社会和经济的影响。我们检索了7个电子数据库，截至2023年12月31日，查找社区主导的传染病控制的整群随机试验和经济评估。参考文献检索确定了与符合条件的数据库记录相关的其他研究。数据提取和叙述性综合总结了关于影响、成本和成本效益的证据，描述了社区参与的性质和程度，并考察了实施情况、影响机制和背景。使用Cochrane偏倚风险工具和Drummond清单评估偏倚风险。我们的数据库搜索产生了14269条记录。经过数据库和参考文献筛选，我们纳入了来自16项独特整群随机试验的49条记录，大部分来自撒哈拉以南非洲。传染病策略包括提供生物医学产品、环境改造以及教育和宣传。基于具有中度偏倚风险的证据，我们发现社区主导的策略可以改善腹泻病、艾滋病毒、疟疾和被忽视热带病的健康行为。对死亡率和发病率、医疗保健获取和利用以及社区和社会成果影响的证据不太确凿。影响取决于社区行为者的实施强度。促进实施的因素包括积极性、信任和卫生系统参与。背景影响包括围绕传染病的态度和规范。经济研究较少，许多研究忽略了社会成本和后果。本综述支持社区主导的传染病控制作为改善健康行为和促进可持续发展目标的潜在有效策略。实施和评估的操作指南对于支持这一重要领域的快速证据生成至关重要。
